Case 8:16-cv-02257-CJC-DFM Document 233-1 Filed 04/20/18 ... Seaman Decl ISO... · Case...

Case 8:16-cv-02257-CJC-DFM Document 233-1 Filed 04/20/18 of 13 Page ID #:8717

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EXHIBIT A

Exhibit A -

Case 8:16-cv-02257-CJC-DFM Document 233-1 Filed 04/20/18 Page 6 of 13 Page ID #:8722

1116000.03/LA

____________, 2018

{{INVESTOR NAME FIELD}}

{{INVESTOR ADDRESS FIELD}}

{{INVESTOR ADDRESS FIELD}}

NOTICE LETTER REGARDING INVESTOR CLAIM

You are receiving this letter as an investor in [Insert A].

Thomas A. Seaman ("Receiver") has been appointed as receiver by a United States District

Court to take control of those companies. More information about the Receiver is available at the

website [______________________]. Among other things, the Receiver reviews claims by

investors and creditors against the companies.

The purpose of this letter is to ask you to verify the amount of your investment in the

companies. Below, the Receiver states what he believes you invested in the companies. If the

information in this letter is correct, you should date and sign the letter in the space provided below

and fax, mail or scan and email this fully executed letter to the Receiver on or before

[_________________, 2018.]

The Receiver's records show the following information about your investment:

Investor No.:__________{{Field}} Investment Entity:_____________________

Total Capital Contribution (Principal Investment) You Made: $___________________

Funds Previously Returned to You: $___________________

If the information above is not correct, then you may tell the Receiver the correct

information by providing the correct information in the below fields. Importantly, you may not

claim amounts that you may have paid as administrative fees or fees to a broker, investment

adviser, agent or attorney. You may also not claim losses or damages based on unpaid interest or

any profits or return on your investment that you may have expected or been promised, or any

other damages arising from your investment. This letter and claim form is not asking you about

any of those items, and you should not submit those other items to the Receiver at this time.

Please carefully review the information in the box above regarding your investment.

If the information is correct, please date and sign this letter in the

space provide below. The Receiver will use the information he already

has.

If any of the information is not correct, you must provide corrected

information in the below box and provide any back-up documentation

that supports your corrected claim.

Exhibit A -


1116000.03/LA

Corrected Investment Information

Investor No.:__________ Investment Entity:___________________________

Total Capital Contribution (Principal Investment) You Made: $___________________*

* You must send the documents that support your corrected claim amount along with

this letter.

You must respond by returning this letter to the Receiver on or before

______________. You may use one the following methods for

returning the letter to the Receiver:

Mail: [claims address] or

Facsimile: [fax number] or

Email: [claims email address]

If you believe you have other claims that are not related to your EB-5 investment, you must

submit a "Claim Form (For All Claimants Except EB-5 Investors)" by the Claims Bar Date of

______________, 2018. The Receiver believes that most EB-5 investors do not have such other

claims. Examples of other types of claims are things like loans made to the companies or goods

or services sold to the companies that were not paid. If you believe you may have other claims,

you should talk to your attorney, if you have one..

The primary purpose of this letter is to verify that the Receiver has correct information

about your investment in the companies and to inform you of the deadline for submitting your

claim. This letter does not mean that you will or that you will not receive money from the Receiver,

and it does not mean you will get the amounts stated in this letter or any other specific amount, if

any.

If you have questions about this letter, you should talk to your attorney if you have one.

If you need help on how to submit information to the Receiver, such as using the claims

internet site, you may email the Receiver's office: at __________ .The Receiver cannot provide

legal or tax advice to you about your investment or claims. If you have an attorney, please direct

legal questions to your attorney.

[Signature]

Thomas A. Seaman

Court-Appointed Receiver

By signing my name below, I affirm that: the answers provided herein are truthful; I will

supplement this form if any information later becomes inaccurate or incomplete; and that I

understand that this form is submitted under penalty of perjury.

Signature: __________________________________________ Dated _________________________________________

Name: ______________________________________________ Title (if any) ____________________________________

Exhibit A -


EXHIBIT B

Exhibit B -


1115998

UNITED STATES DISTRICT COURT

CENTRAL DISTRICT OF CALIFORNIA

SOUTHERN DIVISION

CASE NO. 8:16-cv-02257-CJC-DFM

SECURITIES AND EXCHANGE COMMISSION vs. EMILIO FRANCISCO; PDC CAPITAL GROUP, LLC; CAFFE PRIMO INTERNATIONAL, INC.; SAL ASSISTED LIVING, LP; SAL CARMICHAEL, LP; SAL CITRUS HEIGHTS, LP; SAL KERN CANYON, LP; SAL PHOENIX, LP; SAL WESTGATE, LP; SUMMERPLACE AT SARASOTA, LP; SUMMERPLACE AT CLEARWATER, LP; SUMMERPLACE AT CORRELL PALMS, LP; TRC TUCSON, LP; CLEAR CURRENTS WEST, LP; CAFFE PRIMO MANAGEMENT, LP; CAFFE PRIMO MANAGEMENT 102, LP; et al.

CLAIM FORM

(FOR ALL CLAIMANTS EXCEPT EB-5 INVESTORS)

THIS SPACE RESERVED FOR ADMINISTRATIVE USE ONLY

If you are an EB-5 investor, you should receive a "Notice Letter Regarding Investor Claim." Please use that notice, not this form, regarding your EB-5 investment.

□ Check this box if this claim amends a previously filed claim, dated ______________________

1. NAME AND ADDRESS OF CLAIMANT

__________________________________________________________________________________________________ Name

______________________________________________________________________________________________________________

Address ______________________________________________________________________________________________________________

City / State / Zip Code/ Country

If Claimant is an entity, name of contact person for Claimant:________________________________________________

Telephone No. of Claimant: _____________________________________________________________________

Email address of Claimant: _____________________________________________________________________

Last four digits of Tax I.D. No. or SSN: ____________________ Account or Reference No: _____________________________

2. CLAIM

2a. Basis of Claim:

Goods Sold

Services Performed

Money Loaned

Taxes

Wages, salaries or compensation (fill out below)

Unpaid compensation for services performed

from ___________ to ___________ (dates);

Title:____________

Benefits (provide attach a detailed explanation)

Investment (other than EB-5 Investor)

Other (provide a detailed explanation on attached sheet)

2b. Entity/Person with whom claim was incurred:

___________________________________________

2c. Date Claim was Incurred: ________________________

2d. Total Claim as of January 5, 2017: $_____________

2e. Identify any other party who you claim may be liable to you for

repayment of your claim:

________________________________________________________

2f. If Legal Action Pending, Date Commenced, Court and Case No.:

_______________________________________________________

_______________________________________________________

If Court Judgment, Date Obtained:_________________________

2g. Check this box if you contend your claim is subject to a security

interest. Attach copies of all security agreements and other

documents that evidence the claim of secured status.

2h. Check this box if claim includes interest or other charges, such

as attorney's fees, lost profits, or late fees in addition to the

principal amount of the claim. Attach itemized statement of all

interest or additional charges.

3. If you checked "Investment" above, please provide the following additional information:

3a. Entity In or With Which You Claim To Have Invested: If more

than one, provide a separate Claim Form for each entity)

______________________________________________________

_

3b. Nature of investment:

______________________________________

3c. Please attach a statement of date and amount of funds paid or

value provided and any distributions or withdrawals (including

interest, dividends, returns of principal or rent payments)

3d. Total Amount of Claim as of January 5, 2017: $______________

Check this box if claim includes increases over principal invested,

interest or other charges, such as attorneys' fees, damages, claims or

late fees in addition to the principal amount of the claim. Attach

itemized statement of all additional amounts, interest or charges.

Check this box if you contend your claim is an interest in specific

property. Attach statement identifying such property and describing

your interest.

4. Supporting Documents: Attach copies of supporting documents, such as canceled checks (front and back), account ledgers, bank statements,

promissory notes, purchase orders, invoices, itemized statements of running accounts, contracts, court judgments, mortgages, security

agreements, and evidence of lien perfection. DO NOT SEND ORIGINAL DOCUMENTS. If the documents are not available, explain. If the

Exhibit B -


1115998

documents are voluminous, attach a summary.

5. □ Check this box if you have asserted any claims for damages related to your claim against third parties. If so please attach a brief

description and state the amount of money recovered, if any.

6. Date-Stamped Copy: To receive an acknowledgement of the filing of your Claim Form, enclose a stamped, self-addressed envelope and an

additional copy of this Claim Form.

7. Signature: Sign and print the name and title, if any, of the claimant or other person authorized to submit this claim (attach a copy of power of

attorney, death certificate or other authorizing documents as needed).

By signing your name below, you are certifying that the information contained in this Claim Form and any back-up documentation

provided is true and correct under penalty of perjury under the laws of the United States of America.

Signature: _________________________________ Name: ________________________________ Title (if any) _____________________

8. Dated: YOU MUST DATE AND SIGN THIS FORM FOR THIS CLAIM TO BE VALID

ADDITIONAL INFORMATION

(ATTACH ADDITIONAL SHEETS IF NECESSARY)

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

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________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

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________________________________________________________________________________________________________________

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________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

Exhibit B -


1116929.01/LA

INSTRUCTIONS FOR CLAIM FORM (FOR ALL CLAIMANTS EXCEPT EB-5 INVESTORS)

UNITED STATES DISTRICT COURT

Central District of California, Southern Division SECURITIES AND EXCHANGE COMMISSION vs. EMILIO FRANCISCO; PDC CAPITAL GROUP, LLC; CAFFE PRIMO INTERNATIONAL, INC.; SAL ASSISTED LIVING, LP; SAL CARMICHAEL, LP; SAL CITRUS HEIGHTS, LP; SAL KERN CANYON, LP; SAL PHOENIX, LP; SAL WESTGATE, LP; SUMMERPLACE AT SARASOTA, LP; SUMMERPLACE AT CLEARWATER, LP; SUMMERPLACE AT CORRELL PALMS, LP; TRC TUCSON, LP; CLEAR CURRENTS WEST, LP; CAFFE PRIMO MANAGEMENT, LP; CAFFE PRIMO MANAGEMENT 102, LP; et al.

Case No. 8:16-CV-02257-CJC-DFM

GENERAL INFORMATION Thomas A. Seaman is the Court-appointed Receiver in the above-captioned case. He is responsible for reviewing Claim Forms, and when appropriate, objecting to claims. The purpose of the Claim Form is to help the Receiver learn who you are, how much you are owed, the reason(s) you have a claim, and how the Receiver can contact you. Unless otherwise ordered by the Court, if you fail to submit a Claim Form by _________________, 2018, you will lose your right to receive any distributions from the Receiver or the receivership estate and your claim will be barred.

1. WHO MUST FILE A CLAIM FORM? You must file a Claim Form if you believe you have any claim against:

EMILIO FRANCISCO; PDC CAPITAL GROUP, LLC; CAFFE PRIMO INTERNATIONAL, INC.; SAL ASSISTED LIVING, LP; SAL CARMICHAEL, LP; SAL CITRUS HEIGHTS, LP; SAL KERN CANYON, LP; SAL PHOENIX, LP; SAL WESTGATE, LP; SUMMERPLACE AT SARASOTA, LP; SUMMERPLACE AT CLEARWATER, LP; SUMMERPLACE AT CORRELL PALMS, LP; TRC TUCSON, LP; CLEAR CURRENTS WEST, LP; CAFFE PRIMO

MANAGEMENT, LP; CAFFE PRIMO MANAGEMENT 102, LP; et al., or their respective subsidiaries and affiliates (collectively, the "Companies").

This includes any claim that you are owed money by any of the Companies; assert any interest in any of the Companies or in any of its assets or in any claim against any of the Companies or any entity under its control; or assert any claim of any sort against any of the Companies whether such claim is based upon contract, contribution, indemnity, reimbursement, subrogation theories or other legal or equitable theory. Claim forms must be submitted by claimants who were investors or creditors of any type (including employees) of the Companies. If you are both an investor and creditor, or are an investor in or creditor of more than one of the Companies or affiliates or subsidiaries, please file a separate Claim Form for each and every claim or interest you allege to have against them or any of them. If you are an EB-5 investor you should receive a Notice Letter Regarding Investor Claim from the Receiver to review and, if necessary pursuant to the instructions in such form, return; you should not use this general Claim Form for your EB-5 investment. As to all other claimants, failure to submit a signed Claim Form and supporting documentation will result in the denial of your claim.

2. CONSENT TO JURISDICTION OF THE COURT AND THE CONSEQUENCES THEREOF. If you submit a Claim Form in this

case, you consent to the jurisdiction of United States District Court, Central District of California, Southern Division ("District Court") for all purposes, agree to be bound by its decisions, including a determination, among other things, as to the validity and amount of your claim against the above-captioned Companies, affiliates, subsidiaries or other persons or entities as identified in paragraph 1. In submitting a Claim Form, you agree to be bound by the actions of the District Court even if that means that a claim is limited or denied. By submitting a Claim Form, you further agree that your participation in any distribution of the receivership estate may exclude or prevent you from pursuing other remedies.

3. HOW ARE CLAIMS SUBMITTED? You can send a completed Claim Form, along with all supporting documentation, by mail to

___________________; by email to _____________; or by facsimile to ___________________. Please submit only one claim form per claim. Please do not send or file claim forms with the Court.

4. WHAT IS THE DEADLINE TO SUBMIT THIS CLAIM FORM? The Claim Form must be received by ____________________,

2018. Please note that, unless the Court orders otherwise, any late filed claim may be denied in its entirety.

5. SUPPORTING DOCUMENTS. You must attach to the Claim Form copies of all documents that show that the Companies owe the

debts or amounts claimed, or if the documents are too lengthy, a summary of those documents. If supporting documents are not available, you must attach an explanation of why they are not available. Failure to provide such documents may result in the denial of your claim.

6. ADDITIONAL INFORMATION. Additional information regarding filing the Claim Form, along with additional blank forms, can be

obtained at _____________________[WEBSITE] or you may write to the [Receiver/EPIQ] at the following address: _________________________.

7. TAX AND LEGAL ADVICE. The Receiver and the claims administrator, including the help line, cannot provide tax or legal advice.

You are encouraged to seek independent advice regarding tax and legal issues in regard to filing your claim.

Exhibit B -


1116929.01/LA -2-

INFORMATION ON COMPLETING THE CLAIM FORM

1. Information about Claimant. Complete this section giving the name, address, telephone number and email address of the

Claimant who is asserting a claim against the Companies, and any account or reference number associated with such debt. If the Claimant is an entity, please provide contact information for an authorized representative.

2. Claim information. 2a. Please indicate the basis of your claim in this section. 2b. Entity/Person with whom claim was incurred: Please identify the person or entity you believe owes you the money. 2c. Date the Claim was Incurred. Please indicate the date on which the amount you allege to be owed arose. 2d. Total Claim Amount as of January 5, 2017. Please state your claim amount as of January 5, 2017. 2e. Other liable parties. Please identify any other party you believe may be liable to you on the claim. 2f. Pending Legal Action. If you have commenced a legal action against any of the above-captioned defendants, please

provide the details of said legal action here. Please attach any additional pages of description and supporting documentation. Also, please provide any information regarding court judgments obtained against any of the above-captioned defendants.

2g. Security interest. Please mark the applicable box if you contend your claim is subject to a security interest, and attach

copies of all security agreements and other documents that evidence the claim of secured status. 2h. Claim above principal amount. Mark the applicable box if your claim amount includes interest or other charges, such

as attorneys' fees, loss profits, or late fees in addition to the principal amount of your claim, and attach an itemized statement of all such additional charges.

Please feel free to provide additional pages of explanation or narrative discussing your claim.

3. Investment information. 3a. Please indicate the name of the entity in which you claim to have invested funds, other than as an EB-5 investor making

an EB-5 investment. If you are an EB-5 investor you should receive a Notice Letter Regarding Investor Claim from the Receiver to review and, if necessary pursuant to the instructions in such form, return; you should not use this general Claim Form for your EB-5 investment.

3b. Nature of the investment. Please describe the nature of the investment (stock, limited liability company membership,

etc.) 3c. Date and Amount of Funds Invested and Distributed/Withdrawn. Please attached a statement of each time you

made an investment with the applicable Company by indicating the investment date and the investment amount and of any distributions or withdrawals from the applicable Company by indicating the date and amount of each said distribution or withdrawal.

3d. Claim Amount. Please state the amount you invested or paid to the Company or their predecessors, affiliates or subsidiaries as of January 5, 2017. If the stated amount includes increases over principal invested, such as interest,

attorneys' fees, damages, claims or late fees, please mark the appropriate box below the claim amount and provide a detailed break-down of the claim. If you claim an interest in a specific property or asset, mark the appropriate box in this section and attach a statement identifying the property and interest.

4. Supporting Documentation. In addition to filing out the Claim Form, you should provide supporting documentation evidencing

your claim. Supporting documentation may include documents such as stock certificates, promissory notes, purchase orders, invoices, itemized statements of running accounts, contracts, court judgments, mortgages, security agreements, or evidence of perfection of liens.

5. Third Party Actions. If you have asserted any claims for damages related to your claim against third parties, please check the

box and attach a brief description and state the amount of money recovered, if any.

6. Date-stamped Copy. To receive an acknowledgement of the filing of your Claim Form, enclose an additional copy of the Claim

Form, along with a self-addressed, stamped envelope when filing the original form.

7. Signature. Sign the Claim Form and indicate your title, if applicable.

8. Date. Insert the date on which you completed and signed the Claim Form.

Exhibit B -


Case 8:16-cv-02257-CJC-DFM Document 233-1 Filed 04/20/18 ... Seaman Decl ISO... · Case...

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